Population Pyramids

                                                  
Figure 1: High birth and death
rates, typical of pre-industrial
society

Figure 2: Decreasing death rates,

typical of increasing prosperity

Figure 3: Low birth and death

rates, typical of wealthy countries

Figure 4: Rapid change in birth

rates, typical of dire political or
economic conditions
Classification of Study Designs

Source: Grimes DA, Schulz KF. Lancet 2002; 359: 58

 Cohort Studies

Study
Population

Exposure is
self selected

Exposed Non-exposed
Follow through
time

Disease No Disease Disease No Disease

 Cohort Study

•  Directionality: Always forward

•  Timing: Prospective or Retrospective/
Historical
 Case-Control Studies

Study
Population

Cases Controls

Had Exposure No Exposure Had Exposure No Exposure

 Case-Control Study

•  Directionality: Always backwards

•  Timing: Always Retrospective
 Cross-Sectional Study

•  Directionality: Always Non-directional

•  Timing: Always Retrospective
For Nos. 1 to 5, choose from the following the study
design described or used:
A. cohort B. case-control
C. cross-sectional D. experimental

1. A design that is often used when the

investigator is interested in rare diseases.

2. A design that is often used when the investigators

are interested in rare exposures.

3. The most appropriate study design to examine

the natural history of the disease.
For Nos. 1 to 5, choose from the following the study
design described or used:
A. Cohort B. case-control
C. cross-sectional D. experimental

4. A study of the pattern of occurrence of drug abuse by

age, sex, occupation, educational attainment and
income.

5. Knutson et al (1981) treated wound, burn and ulcer

patients using granulated sugar combined with
povidone-iodine (Betadine). The study was undertaken
from January 1976 to August 1980; during that time, 759
patients were treated. Of these, 154 were treated with
the standard therapy and the remaining 605 were
treated with sugar. The investigators reported that a
much lower percentage of patients treated with the sugar
and povidone-iodine mixture required skin grafts than
those given the standard treatment; the therapy was
painless, and changing the burn dressings was
facilitated.
}  What type of study design is this?

}  On what basis did you decide which type of

study it represents?
}  Calculate and interpret the measures of
association which could be calculated for
these data.
Several researchers felt that certain dietary
habits increased one's chances of
developing colon cancer. A study was
designed to test this belief. The
investigators identified a group of patients
whose initial diagnosis on admission to the
hospital was colon cancer. A group of
patients admitted to the hospital for non-
cancer reasons was ascertained as a control
group. Then the patients of both groups
were interviewed to find out about their
dietary habits. The interviewers did not know
which patients had cancer and which did not.
Table 1. Dietary History of Hospital Patients
With and Without Colon Cancer

With Without
Cancer Cancer TOTAL
Poor Diet 862 1211 2073
Proper Diet 56 342 398

TOTAL 918 1553 2471

}  What type of study design is this?
Case-control study

}  On what basis did you decide which type of

study it represents?
Initial classification – disease status
Time sequence – retrospective
Comparisons – proportions with
risk factor/exposure
}  Calculate and interpret the measures of
association which could be calculated for
these data.

Odds Ratio = (862) (342) = 4.35

(1211) (56)

The odds of having colon cancer is 4.35

times greater for those who have a poor diet
compared to those who have a greater diet.
An earlier study of coronary heart disease
and personality type had been conducted
where trained investigators were sent out to
interview a random sample of people aged 40
to 59 in a small community. Each respondent
was asked questions which established his
personality as A or B, and a medical history
was taken to determine the presence or
absence of coronary heart disease.
 CHD CHD
Present Absent TOTAL

Type A 80 1773 1853

BEHAVIOR
PATTERN
Type B 33 1636 1669

TOTAL 113 3411 3524

}  What type of study design is this?
Cross-sectional study

}  On what basis did you decide which type of

study it represents?
Initial classification – disease status & risk factor
Time sequence – concurrent
Sample represents – surviving persons
Comparisons – proportion with outcome
- proportion with risk
factor/exposure
}  Calculate and interpret the measures of
association which could be calculated for
these data.

Prevalence Odds Ratio =

(80) (1636) = 2.24
(33) (1773)

The odds of having coronary heart disease is

2.24 times greater for those who have a Type A
personality compared to those who have a
Type B personality.
Some recent studies have investigated the possible
relationship of psychological variables and coronary
heart disease (CHD). In one study involving a
personality variable, a random sample of persons
without the disease was classified as having
behavior pattern type A or type B. These persons
were then followed over a period of time to see how
many developed CHD.

Type A behavior pattern person is defined as

manifesting an intense sustained drive for
achievement and as being continually involved in
competition and deadline.
Type B is a more relaxed person, not showing this
intense drive and involvement in competition. The
investigators felt that the Type A personality would
exhibit a greater amount of CHD because of the
physiological stress of their way of life.

The following data resulted from the study -

 CHD CHD
Present Absent TOTAL

Type A 94 1602 1696

BEHAVIOR
PATTERN
Type B 39 1580 1619

TOTAL 133 3182 3315

}  What type of study design is this?
Prospective cohort study

}  On what basis did you decide which type of

study it represents?
Initial classification –risk factor
Time sequence – prospective
Sample represents – non diseased persons
Comparisons – proportion with outcome
}  Indicate the appropriate computations which
could be calculated for these data.

Incidence in exposed = a/(a+b)

= (94/1696) x 1000
= 55.4 per 1000
Incidence in not exposed = c/(c+d)
= (39/1619) x 1000
= 24.1 per 1000
Relative risk = IE/INE = 55.4/24.1 = 2.30
The risk of CHD among those with Type A
personality is 2.3X that of those with Type
B personality
}  A life verse is a verse from the Bible (or a
small passage) that you choose to be your
most favorite verse; it is the one that you
commit to memory to share with others. 



}  Proverbs 3:5-6
New International Version (NIV)

5 Trust in the LORD with all your heart


and lean not on your own understanding;

6 in all your ways submit to him,


and he will make your paths straight.[

}  Philippians 4:13

New International Version (NIV)

I can do all this through him who gives

13

me strength.
}  Jeremiah 29:11-13
New International Version (NIV)

11 For I know the plans I have for you,” declares

the LORD, “plans to prosper you and not to
harm you, plans to give you hope and a future.
12 Then you will call on me and come and pray

to me, and I will listen to you. 13 You will seek

me and find me when you seek me with all
your heart.